Career Impact of Palliative Care Fellowship Training for Nurse Practitioners.

Background: Postgraduate fellowship training for nurse practitioners (NP) in palliative care can ameliorate workforce shortages; however, currently there are few NP fellowships and little evidence about outcomes, such as retention in hospice and palliative nursing, job satisfaction, or professional contributions. Objective: To describe the impact of palliative care fellowship training on the careers of NP alumni. Methods: A survey was electronically distributed to all NP alumni of an interprofessional palliative care fellowship since adult and pediatric nursing cohorts were added (2009-2022). Results: Most respondents still worked in hospice and/or palliative care; a majority of them engaged in professional activities beyond clinical work and reported high career satisfaction. Alumni endorsed multiple benefits of postgraduate fellowship except for post-fellowship compensation. Conclusions: NP palliative care fellowship alumni reported multiple career benefits including job satisfaction, professional accomplishment, and ongoing employment at their training institutions.

Impact of general practice/family medicine training on Japanese junior residents:reflective writing analysis using text mining.

BACKGROUND: We previously reported the impact of general practice/family medicine training on postgraduate training in Japan using evaluation criteria standardized nationwide. However, there is a possibility that new insights may be gained by analyzing the reflective reports written by these residents. METHODS: Junior residents who participated in one-month general practice/family medicine training at one of five medical institutions with full-time family medicine specialists between 2019 and 2022 were enrolled in this study. They were assigned to submit a reflective report on their experiences and thoughts every day during the training. We analyzed these reflective writings using text mining and created a co-occurrence network map to see the relationship between the most frequently used words. RESULTS: Ninety junior residents participated in the study. The words that appeared most frequently in the sentences referring to clinical ability included "symptoms," "medical examination," "consultation," "treatment," and "examination." The words of "family" and "(patient) oneself" showed strong association in the co-occurrence network map. CONCLUSION: It was suggested that general practice/family medicine training greatly contributes to the acquisition of clinical abilities and deepens the learning of junior residents not only about patient care but also about family-oriented care.

Mastering your fellowship: Part 4, 2024.

The 'Mastering your Fellowship' series provides examples of the question format encountered in the written and clinical examinations for the Fellowship of the College of Family Physicians of South Africa (FCFP [SA]) examination. The series is aimed at helping family medicine registrars prepare for this examination. Model answers are available online.

Curriculum development in Liberia's first postgraduate psychiatry training programme.

This paper describes the implementation of curricula for Liberia's first-ever psychiatry training programme in 2019 and the actions of the only two Liberian psychiatrists in the country at the time in developing and executing a first-year postgraduate psychiatry training programme (i.e. residency) with support from international collaborators. It explores cultural differences in training models among collaborators and strategies to synergise them best. It highlights the assessment of trainees' (residents') basic knowledge on entry into the programme and how it guided immediate and short-term priority teaching objectives, including integrated training in neuroscience and neurology. The paper describes the strengths and challenges of this approach as well as opportunities for continued growth.

Registrars' experience with research in family medicine training programmes in South Africa.

BACKGROUND:  Completion of a research assignment is a requirement for specialist training in South Africa. Difficulty with completion delays graduation and the supply of family physicians. The aim of this study was to explore the experience of registrars with their research in postgraduate family medicine training programmes. METHODS:  An explorative descriptive qualitative study. Extreme case purposive sampling selected registrars who had and had not completed their research on time, from all nine training programmes. Saturation was achieved after 12 semi-structured interviews. The framework method was used for data analysis, assisted by ATLAS.ti software. RESULTS:  The assumption of prior learning by teachers and supervisors contributed to a sense of being overwhelmed and stressed. Teaching modules should be more standardised and focussed on the practical tasks and skills, rather than didactic theory. Lengthy provincial and ethics processes, and lack of institutional support, such as scholarly services and financial support, caused delays. The expertise of the supervisor was important, and the registrar-supervisor relationship should be constructive, collaborative and responsive. The individual research experience was dependent on choosing a feasible project and having dedicated time. The balancing of personal, professional and academic responsibilities was challenging. CONCLUSION:  Training programmes should revise the teaching of research and improve institutional processes. Supervisors need to become more responsive, with adequate expertise. Provincial support is needed for streamlined approval and dedicated research time.Contribution: The study highlights ways in which teaching, and completion of research can be improved, to increase the supply of family physicians to the country.

Are Polish doctors ready to start working right after graduation? The 2023 modification to physicians' postgraduate internship and possible paths forward.

The Polish healthcare system faces many problems, among which the shortage of healthcare professionals is one of the most urgent. In less than ten years, more than twenty Higher Education Institutions (HEIs) have been allowed to add medical programmes to their offer, aiming to increase the number of doctors in Poland. Recently, the healthcare system was faced with a proposal to abolish the mandatory postgraduate internship which has been a mandatory component of medical training for years. Two main reforms were considered. The first one focused on the programme of the internship and aimed to update it. The second one recommended an abolition of the internship. The authors of this article analysed the opinions and positions of key players within the system regarding the postgraduate internship. Opinions in this regard are diverse, leading to the conclusion that additional actions would be required prior to the internship abolition. Undergraduate training has changed and currently students are taught in modern facilities, using new teaching methods. On the other hand, internship allows trainees to improve or even acquire skills they may not have obtained during their studies. The postgraduate internship is an essential part of doctors' training. However, in Poland, there is still a lack of a well-thought, long-term policy or strategy for physicians' workforce development. Our study presents a Polish perspective on common challenges in medical training and workforce policy, highlighting the clash over the growing demand for physicians and the limitations of the existing system.

An appraisal of psychotherapy training during psychiatry residency program in India: A national survey.

Background: The need for psychotherapy training (PT) has been recognized worldwide and is considered an integral component of postgraduate psychiatry training. Our study aims to assess the quality of PT received by psychiatrists during their postgraduate studies and its impact on their current practice. Aim: To evaluate the quality of PT and its effect on the current psychiatry practice. Methodology: An anonymous web-based survey was conducted on registered psychiatrists practicing in India to evaluate the level and quality of PT received during their postgraduate studies. Results: The survey indicates that PT was included in the postgraduate psychiatry curriculum (73.8%). However, more than 50% of responders reported no separate posting, evaluation, logbook, or guidelines related to PT. Most (95.4%) psychiatrists think their PT could have been better. PT was satisfying in medical colleges in terms of inclusion in the curriculum (7.70, P = .021), psychotherapy rotations (16.48, P = <0.001), supervision of sessions (14.80, P = 0.001), lectures on psychotherapy (10.13, P = 0.006), periodic psychotherapy meet/forum (19.35, P = <0.001), maintenance of psychotherapy logbook/records (7.65, P = 0.022), institutional or departmental guideline related to PT (20.55, P = <0.001), and overall quality of PT (22.05, P = .005 and 31.81, P = <.001). Time constraint is the most common (49.9%) barrier in delivering psychotherapy. Conclusion: PT is not well organized, consistent, and uniform in psychiatry training; there is a prevailing sense of inadequacy and dissatisfaction among the country's psychiatrists with a perceived need to improve and learn PT.

Holistic Review of Applicants by the United States Postgraduate Training Programs Is Not Associated With the Percentage of Female Residents.

Introduction Given the underrepresentation of female physicians in most specialties and the aim of holistic review in residency applications to improve the diversity of matriculating resident physicians in the United States (US) postgraduate medical training programs, we examined the association between holistic review and female resident representation among US postgraduate training programs. Methods We conducted a cross-sectional survey of US postgraduate training programs to inquire about their use of holistic review for resident applications (independent variable). The primary outcome was the percentage of female residents in each program, which was obtained along with other program-level characteristics from the Fellowship and Residency Electronic Interactive Database Access (FREIDA) catalog in April 2023. We limited the analysis to the 10 specialties with the most training spots in 2022, including anesthesiology, emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, orthopedic surgery, pediatrics, psychiatry, and surgery (general). We also examined the interactions between holistic review and specialty and the percentage of female faculty using model comparison and simple slopes analyses.  Results Of the 3,364 total programs surveyed from the 10 specialties, 222 (6.6%) responded. Responders and nonresponders had similar program-level characteristics, including program type (e.g., university, community), specialty, and reported minimum board examination scores. Of the 222 responders, 179 (80.6%) reported performing holistic review. The percentage of female residents was 49.0% (interquartile range 37.5 to 66.7) in the no holistic review group and 47.8% (35.4 to 65.0) in the holistic review group (median difference 0.9%, 95% confidence interval -6.7 to 8.3). Furthermore, there was no evidence of interaction between holistic review and either the specialty or the percentage of female faculty on the outcome of the percentage of female residents. Conclusions Holistic review of residency applications in this limited sample of US postgraduate training programs was not associated with the percentage of female residents. The role of holistic review in addressing the imbalance of male and female physicians in the healthcare workforce, particularly between specialties, remains unknown.

Mastering your fellowship: Part 2, 2024.

The 'Mastering your Fellowship' series provides examples of the question format encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP [SA]) examination. The series is aimed at helping family medicine registrars prepare for this examination.

Mastering your fellowship: Part 3, 2024.

The series 'Mastering your Fellowship' provides examples of the question formats encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP [SA]) examination. The series aims to help family medicine registrars (and supervisors) prepare for this examination.

National Survey on Support for Nurse Practitioner and Physician Assistant/Associate Postgraduate Fellowship/Residency Programs and Director Compensation.

Introduction Although there has been a significant and steady increase nationwide in the number of physician assistant/associate (PA) and nurse practitioner (NP) postgraduate residency/fellowship programs, there remains a paucity of research related to the level of operational support available in many of these programs to facilitate specialty training. Therefore, the primary aim of this study is to conduct a national survey to gather foundational data regarding advanced practice provider (APP) postgraduate fellowship/residency operational support and program director total compensation data in the United States. Methodology A descriptive cross-sectional survey consisting of 27 questions was distributed via email to 336 postgraduate NP, PA, joint NP/PA, and certified nurse-midwifery residency/fellowship programs between November 2023 and December 2023. Frequency tables and descriptive statistics were used to summarize the survey data. Additionally, Spearman's rank correlation coefficients were performed to determine the relationship between the dependent variables and the independent variable. Results There was a statistically significant positive relationship between the organization values the postgraduate program and having sufficient administrative time (rs = 0.342, p < 0.001), having adequate support staff (rs = 0.340, p < 0.001), and being fairly compensated (rs = 0.356, p < 0.001) for program roles and responsibilities. Moreover, slightly less than half of respondents reported having adequate support staff and sufficient administrative time to address program responsibilities. Only 50% of respondents believed they were fairly compensated for their position. Respondents moderately agreed that their organization values the postgraduate training program (M = 4.00, SD = 1.00). Conclusions The results of this study highlight the perceptions of postgraduate program directors regarding adequate administrative support and resources to facilitate specialty-specific training for NPs and PAs. Further research is warranted to evaluate the level of operational support needed to develop and sustain postgraduate APP residency/fellowship training programs now and in the future.

Basic Training in Palliative Medicine for Internal Medicine Residents: Pilot Testing of a Canadian Model in Switzerland.

Background: In Switzerland, palliative care (PC) clinical training is well established at undergraduate and specialist postgraduate levels. However, postgraduate nonspecialist training curricula are less documented. Local Problem: A structured curriculum for nonspecialist rotation within internal medicine (IM) in specialized PC wards is lacking. Objective: To pilot two versions of a PC nonspecialist curriculum for IM residents in Swiss PC units. Methods: In the pilot phase, two curricula-short immersion (3-10 weeks, based on the University of Toronto's Internal-Medicine PC Rotation) and standard nonspecialist (11-18 weeks, based on the Canadian Society of Palliative Care Physician Competencies)-were assessed using a mixed-method online survey. One university and two nonuniversity sites participated. The analysis was descriptive. Results: Five residents and eight supervisors of five training rotations (July-October 2023) responded. Overall, curriculum quality and feasibility (content and time) received positive ratings across all groups, with high satisfaction concerning organization, educational design, learning support, climate, experience, and facilities. Nonuniversity sites were generally rated more positively than university sites. Qualitative feedback paralleled these findings, highlighting the curriculum's relevance and fit with learners' needs and suggesting potential simplifications and more personalized planning. Conclusions: Establishing short and standard duration curricula for a PC program is viable and well received by nonspecialist trainees. Future implementation should concentrate on personalized learning objectives and streamlining the content and structure of the competencies. Cooperation within various training settings (university and regional hospitals) as well as on an international level (e.g., Canada-Switzerland) may further improve the quality of the proposed training formats.

Unleashing excellence: using a project management approach to effectively implement a simulation curriculum to improve residents' preparedness.

BACKGROUND: Integrating innovative, simulation-based training programs into medical curricula frequently encounters familiar challenges, including scepticism, limited faculty time, and financial constraints. Recognized for its success in business projects, the Harvard Project Management Theory emerges as a promising approach to optimizing the implementation process and achieving sustainable success. This study endeavours to elucidate the application of project management theory in our implementation process and assess its impact on the clinical preparedness of novice residents. METHODS: The research utilized a structured four-phase implementation strategy-Planning, Build-up, Execution, and Closing-to develop a simulation-based education curriculum. Incorporating project management tools like project charters and risk management tools played a crucial role in facilitating the effective implementation of standardized processes and improved clinical outcomes. Essential components of this innovative management approach encompass stakeholder engagement, milestone definition, and the alignment of institutional policies and processes. RESULTS: A collective of 395 residents actively engaged in eight monthly simulation-based events, reflecting an average participation rate of 39 residents per lecture (± 19). A noteworthy enhancement was observed in the average rating for knowledge gain, with a significant improvement from 5.9/10 to 8.8/10 (p = 0.0001). Participants highlighted the program's considerable impact on future clinical practice (4.7/5) and teamwork (4.8/5) as particularly valuable aspects. The introduction of a novel organizational structure received favourable feedback from faculty members, with a notable rating of 4.8/5 for predictive time planning. Qualitative insights from the evaluation highlighted the significance of targeted incentive schemes in optimizing the implementation process. CONCLUSION: This project underscores the constructive influence of project management principles in designing simulation-based curricula, explicitly focusing on stakeholder engagement, faculty motivation, and data utilization. Adopting the Harvard Project Management Approach emerges as a catalyst for heightened success in curriculum design, contributing to enhanced emergency preparedness among novice residents. The positive outcomes observed in this study provide valuable insights for future implementations, offering a foundation for refining and optimizing medical education programs to meet the evolving needs of learners and stakeholders alike.

Postgraduate medical education in Colombia. Proposals to improve it

After 70 years of the formalization of medical specialties in Colombia, very little progress has been made in the educational models for the acquisition of clinical competencies in these postgraduate programs. Furthermore, although there is already a law on human resources in health, the Colombian medical education system lacks specific regulations on the training of health professionals (physicians) in the different medical specialty programs offered in the country. Likewise, at present, factors such as the financial crisis of public hospitals, the limited number of accredited hospitals and the growing number of medical schools and specialization programs, affect the comprehensive and equal development of medical competencies of professionals who are trained as specialists in the different postgraduate medical programs offered in Colombia. In view of the above, the purpose of this article is to present a proposal for postgraduate medical education that prioritizes the adequate acquisition of competencies over compliance with the time required to complete the curricula of the different medical specialties. However, this involves several prerequisites: a regulatory body in charge of overseeing and monitoring the training of medical residents or specialists in the country; strong training in university teaching for professors practicing in medical schools and university hospitals; the standardization of the graduates profile; adequate financing of university hospitals, as well as appropriate support in the process of accreditation as such, and the self-evaluation and continuous improvement of postgraduate medical programs.

Después de 70 años de la formalización de las especialidades médicas en Colombia, ha habido muy pocos avances en los modelos educativos para la adquisición de competencias clínicas en estos programas de posgrado. Además, a pesar de que ya hay una ley sobre el talento humano en salud, en el sistema educativo médico colombiano no hay regulaciones específicas sobre la formación de profesionales de la salud (médicos) en los diferentes programas de especialidades médicas ofrecidos en el país. Igualmente, en la actualidad factores como la crisis financiera de los hospitales públicos, el escaso número de hospitales acreditados y el creciente número de facultades de medicina y de programas de especialización afectan la adquisición integral e igualitaria de competencias médicas de los profesionales que se forman como especialistas en los diferentes programas de posgrado médico ofrecidos en Colombia. Teniendo en cuenta lo anterior, el propósito de este artículo es presentar una propuesta de educación médica de posgrado que priorice la adecuada adquisición de competencias por encima del cumplimiento del tiempo fijado para completar los planes de estudios de las diferentes especialidades médicas. Sin embargo, para esto se requieren varios aspectos: un ente regulatorio encargado de vigilar y monitorear la formación de los residentes o especialistas médicos en el país; una fuerte capacitación en docencia universitaria a los profesores que ejercen en las facultades de medicina y hospitales universitarios; la homogenización del perfil de los egresados; una adecuada financiación de los hospitales universitarios, así como un apropiado acompañamiento en su proceso de acreditación como tal, y la autoevaluación y mejoramiento continuo de los posgrados médicos.

Mastering your fellowship: Part 1, 2024.

The series, 'Mastering your Fellowship', provides examples of the question formats encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians (South Africa) (FCFP [SA]) examination. The series is aimed at helping family medicine registrars (and their supervisors) in preparing for this examination.

Cardiology residents' attitudes towards clinical supervision: a multi-centered study.

PURPOSE: Residents' gender, residency level, and hospital types might influence their attitudes towards clinical supervision (CS); however, reports of its impact on cardiology residency are nonexistent. We explore the effect of gender, residency level, and hospital location's effect on Indonesian cardiology trainees' attitudes towards CS. METHODS: A multi-centered, cross-sectional study was conducted. We invited 490 Indonesian cardiology residents in September- October 2019 to complete the Cardiology CS Scale. Residents' attitudes, gender, university, and residency year were expressed using descriptive statistics. A Mann-Whitney test analyzed the gender and university location effect on residents' attitudes. Training year and university's impact were subjected to the Kruskal-Wallis test; a p-value of <0.05 reflected a significant result. RESULTS: A total of 388 residents agreed to participate (response rate=79.18%). Most of them were male (n=229 [59,02%]), attended universities in Java Island (n=262 [67,52%]), and were in their 2nd-3rd year of training (n=95 [24.48%], each). There were no significant differences in residents' attitudes between genders (U [Nmale=229, Nfemale=159]=17,908.50, z=-0.27, p=0.78). Generally, their attitudes were significantly affected by the university (H(7)=47.38, p<0.01). However, the university location (located in Java Island or outside Java Island) does not affect residents' attitude towards CS (U [NJava=262, Nnon-Java=126]=15,237.00, z=-1.23, p=0.22). In addition, the residents' training year also affected the residents' response (H(2)=14.278, p<0.01). CONCLUSION: Cardiology residents' attitudes towards CS are significantly influenced by training year and university but not gender or university location. The results might provide insightful information for further improvement of CS in cardiology training and guide further evaluation.

Survey of Pediatric Pharmacy Residency Program Directors and Former Residents on Post-Graduate Training Paths.

Objective: There are currently no data comparing outcomes of traditional vs pediatric-focused PGY1 residency programs. The primary objective of the survey was to identify if a difference in resident preparedness for a PGY2 pediatric pharmacy residency exists between these PGY1 program types. Methods: This survey-based study included all PGY2 pediatric residency program directors (RPDs) in 2021 and PGY2 pediatric pharmacy residents who completed residency between 2016-2020. Information regarding training paths of residents, such as type of PGY1 completed, and preparedness at the start of a PGY2 pediatric residency was collected. Preparedness for both general and pediatric-specific elements were assessed. Results: A total of 101 respondents were included: 36 RPDs and 65 previous residents. RPDs felt residents who completed a pediatric-focused PGY1 were more prepared in baseline knowledge of pediatric diseases; otherwise, residents were similar across residency types in their perceived preparation for a PGY2. Pediatric-focused PGY1 residents felt significantly more prepared in pediatric baseline knowledge (96% vs 75%, p = 0.002) and managing pediatric emergencies (96% vs 50%, p = 0.002) than those who completed a traditional PGY1 program. There was no difference for patient care or clinical research skills. Residents in both groups obtained pediatric pharmacist jobs and felt equally prepared for transitioning into their first post-residency job. Conclusions: Despite a difference between the PGY1 resident groups in perceived baseline pediatric knowledge and preparedness to manage pediatric emergencies, similar post-residency jobs were obtained. Respondents felt equally prepared to begin their pediatric careers regardless of the type of PGY1 residency completed.

Medical registrars at the University of the Free State: Burnout, resilience and coping strategies.

BACKGROUND:  Burnout among doctors has been linked with decreased quality of patient care. The coronavirus disease 2019 (COVID-19) pandemic highlighted the need to protect doctors' mental health and well-being. This study aimed to investigate burnout, resilience and coping strategies among registrars in the MMed programme of the University of the Free State (UFS) in 2020. METHODS:  In this quantitative, cross-sectional study, a link to an online anonymous self-administered questionnaire with socio-demographic questions, perceived stress, Copenhagen Burnout Inventory (CBI), Connor-Davidson Resilience Scale and Brief Cope was emailed to all 278 registrars. RESULTS:  Sixty registrars responded (response rate 21.6%). More than half (55.0%) were male and 73.3% were married. There were 28.3% second- and third-year students, respectively. Most (58.3%) had 5-10 years' work experience. The CBI personal scale had the highest median value (58.3; interquartile range [IQR]: 43.3; 70.8) with 70% scoring ≥ 50. The median score for resilience was 78 of 100 (IQR: 69; 84). There were weak negative correlations between resilience and burnout scores (r = -0.31 to r = -0.37). Planning, positive reframing and acceptance were the most frequently used adaptive coping mechanisms; self-distraction was the most frequently used maladaptive coping mechanism. There was no association between gender and burnout and resilience scores. CONCLUSION:  Registrars were resilient with low levels of patient- and work-related burnout, and higher personal burnout, using mostly positive coping strategies.Contribution: This study gives insight into the well-being of registrars at the UFS during COVID-19. Continuous monitoring and support for this population are essential to foster mental health and well-being.

ANALYSIS OF THE RESULTS OF GP-FM QUESTIONNAIRE REGARDING TRAINING IN THE SPECIALIZATION «OTOLARYNGOLOGY¼ BOTH AT THE UNDERGRADUATE AND POSTGRADUATE LEVELS.

OBJECTIVE: The aim: To research the degree of satisfaction with the training of general practitioners-family medicine (GP-FM) in the specialization "Otorhinolaryngology" in the leading higher educational institutions (HEIs) of Ukraine at undergraduate and postgraduate levels. PATIENTS AND METHODS: Materials and methods: A questionnaire was conducted of 51 GP-FM doctors. RESULTS: Results: The duration of otorhinolaryngology training at a medical HEI was indicated by: 49% of respondents about weeks of training, 19.6% - about months. 31.37% received separate training on ENT examination. 56.9% of people were trained in ENT departments. 76.5% of people were not satisfied with the quality of theoretical knowledge, 52.9% of respondents of practical skills at the undergraduate level. 72.6% of doctors not satisfied with the quality of theoretical knowledge, 56.8% of respondents of practical skills at the post-graduate level. 41.2% of respondents received post-graduate training in otorhinolaryngology at the GP-FM specialization cycle, 72.55% of them in a lecture format. 86.3% of people want to deepen their knowledge of otolaryngology and need to understand the etiopathogenetic mechanisms of ENT pathology. CONCLUSION: Conclusions. The dissonance with the dissatisfaction of the doctors of the GPFM with the quality of the received theoretical knowledge in ENT pathology and the availability of their practical skills was revealed. It is important for GPFM doctors to undergo separate training in ENT examination and pathology with mandatory study and conscious use of etiopathogenetic mechanisms of ENT pathology, especially in inflammatory diseases.